The primary purpose of the proposed plan is to provide the applicant with the means and structure for achieving two immediate goals and one long-term goal. Her long-term goal is to become an independent investigator and leader of a multidisciplinary cancer research team focusing on improving symptom severity in palliative care. To accomplish this goal, she proposes a training program comprising formal coursework, directed readings, seminars, and mentored practicums, including instruction in quantitative analysis and focus-group methodology as well as the studies described below. The immediate goals are [1] to enhance understanding of the difference in symptom occurrence and symptom severity in low income and racially disparate groups of patients with MBC and [2] to better understand the barriers to the use of symptom-management strategies by patients and to determine if these barriers differ based on income or racial factors. In order to accomplish these goals, the candidate will complete two small studies, culminating in a larger study proposal appropriate for an R01 application. Guided by the Dodd Symptom Management Theory, the first study will quantify symptoms and symptom severity among patients with MBC and will measure the influence of race and income status on symptom occurrence and severity. The second study will be qualitative, using focus groups to identify potential barriers to symptom management. The research findings will be foundational to the preparation of a larger research application and future interventional studies for symptom reduction for all patients in palliative care. Training and research activities will take place at the University of Pittsburgh Cancer Institute (UPCI), an NCI-designated Comprehensive Cancer Center; facilities of the University of Pittsburgh Medical Center (UPMC); and the University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Nursing. Supportive activities will take place at the Yale University School of Nursing, Harvard University and through the University of Wisconsin, Milwaukee.